large squamous cell carcinoma, was ulcerated in its central area used in the past. Its excellent blood supply offers the se- (Fig. 1). She underwent a wide resection of the lesion both lateral- curity of primary healing. The procedure is relatively ly and in depth. The latter was down to the periosteum. Complete- bloodless because most of the dissection takes place in ness of excision could not be ascertained because there was no pa- areolar tissue planes. A gluteus maximus flap was uti- thologist available. The defect was reconstructed with a variation lized in a patient with a large neoplasm of the sacral ar- of the gluteus maximums flap. A bilateral advancement of the ea. The approach and the technique utilized for covering muscle measured to cover the sacrum completely and the muscle fibers were sutured together with minimal tension. Elevation of the area are described. the gluteus maximus began along its periosteal origin on the sac- rum and coccyx, and continued below and laterally until the infe- rior insertion of the muscle was completely detached (Fig. 2). To References reduce the tension on the edges of the flap, bilateral linear inci- sions were made superiorly through the skin and subcutaneous tis- 1. Ger R (1971) The surgical management of decubitus ulcers by sue. Burrow's triangles were resected laterally (Figs. 3, 4). After muscle transposition. Surgery 69:106 eight days a dehiscence of 4 cm was observed in the middle third 2. Stallings JO, Delgado JR Converse JM (1974) Turnover island of the vertical wound, this was resutured after one week and flap of gluteus maximus muscle for the repair of sacral decu- healed well. The patient was satisfactory postoperatively and was bitus ulcer. Plast Recoustr Surg 54:52 discharged in one week. 3. Minami RT, Mills R, Pardoc R (1977) Gluteus maximus myo- There was no obvious evidence of metastatic disease in this cutaneous flaps for repair of pressure sores. Plast Reconstr patient but this could not be confirmed since radiology was not Surg 60:242 available. 4. Mathes JM, Nahal F (1979) Clinical atlas of muscle and mus- culocutaneous flaps. Mosby, St Louis, pp 91-103 5. Parry SW, Mathes SJ (1980) Bilateral gluteus maximus myo- Discussion cutaneous advancement flaps: sacral coverage for ambulatory patients. Ann Plast Surg 8:443 6. Ramirez OM, Orlando JC, Hurwitz DJ (1984) The sliding glu- The gluteus maximus or myocutaneous flap has many teus maximus myocutaneous flap: its relevance in ambulatory uses in local closure of sacral defects. In this patient a patients. Plast Reconstr Surg 74:68 sliding type of operation was performed with the aim of 7. Strauch B, Vasconez Luis O, Hall-Findlay EJ (1990) Grabb's covering the sacral area, preservation of the structural in- encyclopedia of flaps. Little Brown and Company. Boston, pp tegrity and function of the muscle unit. 1533-1564 8. Fischer J, Arnold PG, Waldorf J, Woods JE (1983) The glute- us maximus musculocutaneous V-Y advancement flap for large sacral defect. Ann Plast Surg 11:517 Conclusion 9. Abenavoli FM (1995) Plastic surgery in the third world. Plast Reconstr Surg 95:1331 The gluteus maximus muscle flap has provided more re- liable coverage of the sacral area than the techniques © Springer-Verlag 1997 Eur J Plast Surg (1997) 20:265 Masquelet, A.C., Gilbert, A.: An atlas of limb reconstruction. and teaching in their many educational courses held twice a year London: Martin Dunitz Ltd. 1995.265 pages, 330 illustrations (74 in Paris. The routine question in any book review: What are the in full color). £ 95,00. ISBN 1-85317-172-7. contents? The Atlas, the text is divided into seven sections. A his- In 1990, these authors from Paris first published a part of their torical review is followed by an outline of the vascular anatomy of opus magnum on the flaps of skin and muscle of the upper ex- the skin, muscle, venous drainage in the reverse arterial flow flap, tremity. It was reviewed in this journal, as was their subsequent and vascular anatomy of the described flaps of the upper and low- book in 1993, on the flaps of skin and muscle of the lower extrem- er limb. Rightfully the properative planning is considered to be the ities, also produced by Springer-Verlag. "If your French is suffi- most difficult part of the surgical intervention. The subsequent cient, if you do this type of plastic surgery, dear reader, this is an chapters deal with transfers of flaps from the upper and from the excellent book for you" was the recommendation at that time. lower extremities: upper arm and forearm, hand and digits; thigh, Now, the authors present, in folia format, a magnificant Atlas lower leg, foot. Also, transfers from the thorax, abdomen, and pel- of flaps in limb reconstruction. Why? Not everyone, unfortunate- vis are discussed as well as the indications for pedicled island ly, has a command of the French language and the patients de- flaps. This Atlas, by two eminent specialists, is the result of long- serve, demand optimal reconstructions with a shortened hospital standing labour and of the pleasure of achievement. The various stay. They want this optimal reconstruction by the superspecialist, surgical techniques, for each flap, are fully illustrated step by step who is in full knowledge of the recent development of this type of by a renowned artist: L6on Dorn. Thus, the reader obtains a well reconstructive surgery: The surgery of loss of substance of the ex- presented and superb guide on each stage of the operation. A five tremities. Of course extremities consist of a little bit more than page bibliography of the main articles and books, dealing with soft tissues! Thus, the aim of this atlas, published in English, is historical data, anatomical studies and clinical applications, con- limited. But the authors are providing the essence and the details cludes this superbly produced Atlas. (L. Clodius, Zfirich) on flap surgery of the extremities, as they have been experiencing
European Journal of Plastic Surgery – Springer Journals
Published: Sep 1, 1997
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